1. Scrutiny and the Voluntary and Community Sector Health Inequalities in London event 29 October 2014 Jessica Crowe Centre for Public Scrutiny

2. who are CfPS? Founded in 2003 to: promote accountable public services influence policy and practice Now a charity, we are a national leader in ideas about accountability and scrutiny in public services: our principles: accountability, transparency & involvement support cross-sector, cross-government learning networks

3. What do we do? Operate in 5 fields of work: Children & Young People (school governance, safeguarding scrutiny) Health & Social Care (funded by DH/NHSE, CQC to support networks & better PPI) Involvement (tenant scrutiny, welfare reform) Local Accountability (council scrutiny practice in England & Wales) Thought Leadership (advocating stronger scrutiny & accountability) Offer skills training & development, governance evaluation & support, online services/briefings, network support & events

4. contents What is scrutiny How can health scrutiny help VCS? Using council scrutiny to have an impact on health inequalities CfPS: Accountability Works! 2010

5. what is scrutiny? Fundamentally: scrutiny is based on the principle that someone who makes a decision… …shouldn’t be the only one to review or challenge it

6. Local authority scrutiny Aims and objectives A core element of local democracy Provide ‘critical friend’ challenge Enable the voice and concerns of the public to be heard Carried out by independent members Drive improvement in public services Gives councillors powers to review, scrutinise and make recommendations for any matter relating to the planning, provision and operation of health services locally. Scrutiny is at its most effective when it can influence and improve service design and delivery – CfPS’s ‘Return on investment’ model of scrutiny helps do this in an inclusive, citizen-focused way

7. Health scrutiny is able to connect different bits of the system – when it works well Using democratic mandate & legitimacy Scrutiny >> accountability Overview >> makes connections and helps see whole system It’s about relationships

8. An inclusive way to scrutinise and improve health inequalities Phase two of our Health Inequalities Programme developed and piloted a new approach with councils which provided: –Robust scrutiny based on impacts, outcomes, measurements, costs. –Integrated Marmot Policy objectives into a review model and a council’s work. –Focused on the wider determinants and their impact on health –Forecast the impact of scrutiny recommendations Result was a model that embeds scrutiny as an effective public health tool and identified potential savings Extended beyond health inequalities: welfare reform & education governance

9. Background - Marmot Review ‘Fair Society, Healthy Lives’ Proposed an evidence based strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age which can lead to health inequalities: Giving every child a good start in life Enabling all children, young people and adults to maximise their capabilities and have control over their lives. Creating fair employment and good work for all. Ensuring a healthy standard of living for all. Creating and developing healthy and sustainable places and communities. Strengthening the role and impact of ill health prevention.

10. Introducing the scrutiny model What it helps areas to do The model is based on five stages of a “scrutiny journey”, utilising a variety of tools: 1.Identifying and short listing topics 2.Prioritisation 3.Stakeholder engagement and scoping 4.Undertaking the review, measuring impact and calculating the Return on Investment 5.Making recommendations using ROI and influencing services

11. Stage two Prioritisation Stage two – has three steps: Producing an Impact Statement Using a “scoring matrix” to choose the topic for review Considering what to measure The impact statements help councillors focus on the policy objectives of the Marmot Review of Health Inequalities

12. Stage 2 - Impact scoring matrix – case study

13. Stage three Stakeholder engagement and scoping Stage three has two steps: Stakeholder engagement Getting started with the review The stakeholder engagement has proved to be an innovative way to engage a wider group of citizens within the review and ensures that Councillors focus on the whole system

14. Stage 3 Stakeholder engagement wheel

15. Stakeholder engagement wheel Identifying gaps and overlaps

16. Benefits – what users thought! Scrutiny is well placed to influence a range of partner agencies and promote more joined-up working Different way of prioritising topics - highlighting a ‘hidden’ issue Raises awareness of the issue – value of networking Good stakeholder engagement looking at difficult and sensitive issue – helps to get all of the right people together Explored issues ‘on the ground’ and agreed a set of recommendations to help improve services Able to demonstrate a return on investment, including: input and output costs, potential cost savings from improving service coordination

17. Case study: scrutiny of maternal health needs of gypsy & traveller population South Somerset: -facilitate networks -focus on patient experience & access -link bigger picture to local experience -provide neutral space -champion marginalised

18. Publications – all on our website

19. Any questions?

20. To find out more www.cfps.org.uk - register on-line or via forms for: - e-newsletters, e-digests & scrutiny exchange - reviews library, on-line forum, latest news - Policy and Skills Briefings Twitter: @CfPScrutiny info@cfps.org.uk or 020 7187 7362 for helpdesk Tipping the scales: http://www.cfps.org.uk/domains/cfps.org.uk/local/media/downloads/L12_379_tipping_the_scales_v 4.pdf Valuing inclusion: http://www.cfps.org.uk/domains/cfps.org.uk/local/media/downloads/L13_30_CfPS_Valuing_inclusio n_v5_Web_final_amends.pdf Checking the nation’s health: http://www.cfps.org.uk/domains/cfps.org.uk/local/media/downloads/CfPS_Nations_Health_final_onl ine.pdf